Healthcare Provider Details

I. General information

NPI: 1023843760
Provider Name (Legal Business Name): ANGEL D DIAZ SANTANA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CALLE HERMINIO DIAZ NAVARRO #5, ESQUINA CALLE TAPIA
GUAYNABO PR
00969
US

IV. Provider business mailing address

313 CALLE GRUS
CAROLINA PR
00979-1384
US

V. Phone/Fax

Practice location:
  • Phone: 787-720-2626
  • Fax:
Mailing address:
  • Phone: 787-409-9677
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number8680
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: